Acute Spinal Cord Injury (SCI)

The spinal cord contains the nerves that carry messages between the brain and the rest of the body. The spinal cord starts at the brain and extends down the neck and back inside the vertebrae.

Acute SCI is a sudden traumatic injury that either results in a bruise, a partial injury or a complete injury to the spinal cord.

Partial SCI: sometimes called an incomplete injury, the spinal cord is able to carry some messages to and from the brain to the rest of the body

Complete SCI: the spinal cord is unable to carry messages to and from the brain to the rest of the body, resulting in a near-total loss of motor and sensory function

Causes of Acute SCIThere are many causes of SCI, but most injuries occur when the area of the spine or neck is bent or compressed. The most common causes of SCI are:

Motor vehicle accidents

Falls

Violence (gunshots or stab wounds)

Sports injuries

Diving accidents

Trampoline accidents

Symptoms of an Acute SCI Symptoms of SCI depend on the severity and location of the injury. Usually, symptoms are more severe the higher up the SCI is. For example, an injury on the neck, at C1 or C2 (the first and second cervical vertebrae in the spinal column), affects the respiratory muscles and the ability to breathe.A lower injury, in the lumbar vertebrae, may affect the nerve and muscle control to the bladder, bowel and legs.The following are the most common symptoms of acute spinal cord injuries. However, each individual may experience symptoms differently. Symptoms may include:

Muscle weakness

Loss of voluntary muscle movement in the chest, arms or legs

Breathing problems

Loss of feeling in the chest, arms or legs

Loss of bowel and bladder function

Types of Acute SCI SCI is classified according to the patient’s type of loss of motor and sensory function. The following are the main classifications:

Quadriplegia (tetraplegia): involves loss of movement and sensation in all four limbs (arms and legs); it affects the chest muscles and may require a mechanical breathing machine for the patient

Paraplegia: involves loss of movement and sensation in the lower half of the body (right and left legs)

Cervical (Near the Neck) Injuries When spinal cord injuries occur near the neck, symptoms can affect both the arms and the legs:

Breathing difficulties (from paralysis of the breathing muscles)

Loss of normal bowel and bladder control (may include constipation, incontinence, bladder spasms)

Loss of normal bowel and bladder control (may include constipation, incontinence, bladder spasms)

Numbness

Sensory changes

Spasticity (overstimulated muscle tissue)

Pain

Weakness, paralysis

Injuries to the cervical or high-thoracic spinal cord may also result in blood pressure problems, abnormal sweating, and trouble maintaining normal body temperature.Lumbar Sacral (Lower Back) Injuries When spinal injuries occur at the lower back level, varying degrees of symptoms can affect the legs:

Loss of normal bowel and bladder control (may include constipation, incontinence, bladder spasms)

Numbness

Pain

Sensory changes

Spasticity (overstimulated muscle tissue)

Weakness and paralysis

Signs and tests

The health care provider will perform a physical exam, including a neurological exam. This will help identify the exact location of the injury, if it is not already known. Some of the person’s reflexes may be abnormal or absent. Once swelling goes down, some reflexes may slowly recover.The following tests may be ordered:

ACT scan or MRI of the spine may show the location and extent of the damage and reveal problems such as blood clots (hematomas)

Myelogram (an X-ray of the spine after injection of dye) may be necessary in rare cases.

Somatosensory evoked potential (SSEP) testing or magnetic stimulation may show if nerve signals can pass through the spinal cord

Spine X-rays may show fracture or damage to the bones of the spine

Treatment A spinal cord trauma is a medical emergency requiring immediate treatment to reduce the long-term effects. The time between the injury and treatment is a critical factor affecting the eventual outcome.

Corticosteroids, such as dexamethasone or methylprednisolone, are used to reduce swelling that may damage the spinal cord.

If spinal cord compression is caused by a mass (such as a hematoma or bony fragment) that can be removed or brought down before there is total destruction of the nerves of the spine, paralysis may in some cases be reduced or relieved.

Ideally, administration of corticosteroids should begin as soon as possible after the injury.

Surgery may be necessary. This may include surgery to remove fluid or tissue that presses on the spinal cord (decompression laminectomy). Surgery may be needed to:

Remove bone fragments

Remove disc fragments

Remove foreign objects

Stabilize fractured vertebrae (by fusion of the bones or insertion of hardware)

Bedrest may be needed to allow the bones of the spine to heal, since they bear most of the weight of the body.

Anatomic realignment is important. Spinal traction may reduce dislocation and/or may be used to immobilize the spine. The skull may be immobilized with tongs (metal braces placed in the skull and attached to traction weights or to a harness on the body).

Treatment will address muscle spasms, care of the skin, and bowel and bladder dysfunction.

Extensive physical therapy, occupational therapy, and other rehabilitation interventions are often required after the acute SCI has healed. Rehabilitation assists the person in coping with disability resulting from spinal cord trauma.

Spasticity can be reduced by many oral medications, medications that are injected into the spinal canal, or injections of botulinum toxins into the muscles. It is important to treat pain with analgesics, muscle relaxants, or physical therapy modalities.Expectations & Prognosis Paralysis and loss of sensation of part of the body are common. This includes total paralysis or numbness and varying degrees of movement or sensation loss. Death is possible, particularly if there is paralysis of the breathing muscles.

How well you do depends on the level of your injury. Injuries near the top of the spine result in more extensive disability than do injuries lower on the spine.

Recovery of some movement or sensation within one week usually means the person has a good chance of recovering more function, although this may take six months or more. Losses that remain after six months are more likely to be permanent.

Routine bowel care frequently takes one hour or more on a daily basis. A majority of people with SCI must perform bladder catheterization from time to time.

Modifications of the person’s living environment are usually required.

Most people with SCI are wheelchair- or bed-bound, or have impaired mobility requiring a variety of assistive devices.Complications Possible complications of SCI can include extreme changes in blood pressure (autonomic hyperreflexia). Other complications of immobility include:

Call 911 if there is any loss of movement or sensation. This is a medical emergency.Management of SCI begins at the site of an accident with paramedics trained in immobilizing the injured spine to prevent further damage to the nervous system. Someone suspected of having a SCI should NOT be moved without immobilization unless there is an immediate threat to their safety.Prevention Safety practices during work and recreation can prevent many spinal cord injuries. Use proper protective equipment if an injury is possible. Diving into shallow water is a major cause of spinal cord trauma. Always check the depth of water before diving, and look for rocks or other possible obstructions.Football and sledding injuries often involve sharp blows or abnormal twisting and bending of the back or neck and can result in spinal cord trauma. Use caution when sledding and inspect the area for obstacles. Use appropriate techniques and equipment when playing football or other contact sports. Falls while climbing at work or during recreation can result in spinal cord injuries. Defensive driving and wearing seat belts greatly reduces the risk of serious injury if there is an automobile accident.Support Groups For organizations that provide support and additional information, seespinal injury resources.